Author of

• 20146

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  OA 11 - Reducing Burden: Patient-Centered Care (ID 682)

  • Event: WCLC 2017
  • Type: Oral
  • Track: Nursing/Palliative Care/Ethics
  • Presentations: 1
  • Moderators:Beth Ivimey, E. Bernicker
  • Coordinates: 10/18/2017, 11:00 - 12:30, Room 313 + 314

  • 24329

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    OA 11.04 - Effect of Early Palliative Care on Aggressiveness of Cancer Care near End of Life in Lung Cancer Patient (ID 8294)

    11:30 - 11:40  |  Author(s): S. Chaiviboontham
    • Abstract
    • Presentation
    • Slides

    Background:
    Aggressive care and chemotherapy worsens quality of life (QoL) of dying cancer patients. Early palliative care (EPC) in patients with metastatic non small cell lung cancer (NSCLC) is associated with improvements in QoL. Thus, we aimed to explore an impact of EPC on the aggressiveness of care at the end of life (EOL).
    
    Method:
    An observational cohort enrolled newly diagnosed metastasis NSCLC at Ramathibodi hospital from 31[st] August 2015 to 1[st] September 2016. In EPC group, the consultation of specialized palliative team was performed ≤ 4 weeks of diagnosis and before start chemotherapy treatment, then monthly visits until death and the last visit for bereavement. The palliative consultation in standard of care (SOC) patients performed as their routine practices. The cutoff date for survival analysis was on 31[st] December 2016. The aggressiveness of care in EOL was defined as the composite outcome as any of the followings: last dose of chemotherapy received < 14 days of death, a new chemotherapy regimen starting < 30 days before death, ≥ 1 hospital admissions or emergency room visits or hospitalizations > 14 days in 30 days of death, or an ICU admission in 30 days of death.
    
    Result:
    105 patients were enrolled, 38 out of 70 patients (54%) in SOC group and 17 out of 35 patients (48%) in EPC group died. More aggressiveness of care at the EOL (97.3% vs 64.7%, p=0.003), more in-patient death (89.5% vs 58.8%; p=0.009) and longer hospitalization before death were observed in the SOC group (12 days vs 4 days, p=0.028). The cost analysis of patients who died at the hospital showed higher hospitalized cost in the SOC group (p=0.005). The EPC group received less aggressive treatments such as using less than 3 regimens of chemotherapy (77.1% vs 94.3%; p=0.028), but the survival rate was not different (11.3 months vs 6.6 months; p=0.08).
    
    Conclusion:
    Early palliative care reduced the aggressiveness of care at the end of life, shortened hospitalization and covered less cost of treatment.
    
    

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